HIV/AIDS and Sexual and Reproductive Health Integration: Quarterly Highlights Newsletter (March 2008)
Contents
- Highlights from the Quarter
- Featured Resources
- Events
- Partner Profiles: Voices from the Field
- Subscription Information
Dual Method Use and Discordant Couples
Professionals involved in integrated service delivery face the challenge of convincing couples to use dual protection methods of HIV and pregnancy prevention, such as condoms and pills. To add to the challenge of promoting dual method use, an article published by Switzerland's Federal AIDS Commission stated that condoms may not always be needed between discordant couples if an antiretroviral regimen is strictly followed and other conditions apply. WHO and UNAIDS shortly after issued a statement reiterating their recommendation of comprehensive HIV prevention measures, including consistent and correct use of condoms. In other news, one study reports that with effective counseling and access to long-acting methods, discordant couples can be convinced to use dual methods.
Female-Controlled Methods of HIV/Pregnancy Prevention Still Researched
Female-controlled methods of HIV/pregnancy prevention continue to be researched. A clinical trial for Buffer Gel Duet shows need for more research in this combination microbicide/spermicide. A Zimbabwe study of cellulose sulfate, an antimicrobial and contraceptive agent, indicated that use of the substance for 6 months appears safe, when used alone or with a diaphragm. Researchers conducted studies in Southern China and South Africa to determine acceptability of hypothetical microbicides, both of which showed promising results.
Male Circumcision and HIV Prevention
A relaxed client undergoes adult male circumcision for HIV prevention in a joint
Source: © 2007 Dr. Inon Schenker/Jerusalem AIDS Project, Courtesy of Photoshare
More research results continue to be released about the relationship between male circumcision and HIV prevention.A New York Times article reported on a study indicating that female partners of men who were circumcised did not experience an HIV prevention benefit and were in fact more at risk if sex was resumed before the circumcision wound was healed. The results raise questions about the need for HIV counseling and testing in concert with male circumcision services to aid couples in knowing their HIV status before a man is circumcised. In other news, researchers reported that in a Merck AIDS vaccine study, uncircumcised volunteers who received the vaccine ran nearly 4 times the risk of infection than those who were given a placebo.
Integrated Adolescent Sexual and Reproductive Health
Adolescents continue to be a focus of integrated SRH programs because of the high risk of youth for HIV/STI infection and unplanned pregnancy. A variety of approaches have been tried, including peer educators, adult mentors, and youth-friendly services and training for providers. The African Youth Alliance (AYA), a partnership to improve adolescent sexual and reproductive health, and prevent HIV/AIDS in Botswana, Ghana, Tanzania and Uganda, reports an evaluation that indicates success of its multi-component approach.
Looking for more information? Try these searches (just paste the URLs in your Web browser to search the HIV/SRH Integration database):
|
Looking for more information? Try these searches (just paste the URLs in your Web browser to search the HIV/SRH Integration database):
Dual Method Use and Discordant Couples Female-Controlled Methods of HIV/Pregnancy Prevention Still Researched Male Circumcision and HIV Prevention Integrated Adolescent Sexual and Reproductive Health |
AIDS vaccine research - back to drawing board
Author: Russell S
Source: San Francisco Chronicle, 6 Feb 2008
URL: http://tinyurl.com/2vlcpc
Following the failure of Merck's three-step HIV vaccine trial, experts are further analyzing the study results and have noted a surprising association with male circumcision. Dr. Susan Buchbinder, chief of HIV research for the San Francisco Department of Public Health and a lead investigator in the Merck drug trial, said that uncircumcised volunteers who received the vaccine ran nearly four times the risk of infection than those who were given a placebo. Buchbinder said one possible explanation is that the vaccine somehow activated white blood cells near the surface of the foreskin - known HIV targets - making them more vulnerable to infection. She told reporters that she would not recommend at this time that study participants who are uncircumcised and received the vaccine, rather than a placebo, be circumcised as a precaution.
Antiretroviral therapy and sexual transmission of HIV
Source: UNAIDS Press Office, 1 Feb 2008
 |
Packages of antiretroviral drugs sit on a table, waiting to be dispensed to AIDS patients in Katutura Hospital Windhoek. Source: © 2005 Alfredo L. Fort, Courtesy of Photoshare. |
URL: http://tinyurl.com/2uhu5j
Following the recent publication of an article on antiretroviral treatment and sexual transmission of HIV in the Swiss medical journal 'Bulletin des médecins suisses', UNAIDS and WHO reiterate the importance of a comprehensive approach to HIV prevention including correct and consistent use of condoms. The article, published by Switzerland's Federal AIDS Commission (La Commission fédérale pour les problèmes liés au Sida), states that seropositive individuals do not risk transmitting HIV to a seronegative partner under the following conditions: The seropositive partner has to have had undetectable HIV in the blood for at least 6 months, there must be strict adherence to his/her antiretroviral regimen, and he/she must be free of any other sexually transmitted infections. In the article the Commission states that although available medical and biological evidence does not rule out the possibility of HIV transmission they feel that there is nonetheless enough information to support its statement. To prevent transmission of HIV, UNAIDS and WHO strongly recommend a comprehensive package of HIV prevention approaches, including correct and consistent use of condoms.
A Phase I study of the functional performance, safety and acceptability of the BufferGel Duet
Authors: Ballagh SA, Brache V, Mauck C, Callahan MM, Cochon L, Wheelessd A, Moench TR
Source: Contraception. 2008 Feb;77(2):130-137.
URL: http://tinyurl.com/2g4jhd
The purpose of this study was to assess the functional performance of the BufferGel Duet, a buffering microbicide and spermicide gel applied to the cervix and vagina by a novel applicator that also serves as a mechanical barrier. This was a noncomparative Phase I safety trial in 30 healthy couples, aged 20-50 years, at low risk for sexually transmitted infections, who agreed to use the gel-device combination twice in 1 week and respond to detailed questionnaires about their experience. The female participants were examined with colposcopy before and 6-18 h after using the second device. Based on written instructions alone, 25 women successfully placed and 28 women successfully removed the device. Three women reported feeling the device dislodge around the time of intercourse. The product was equally acceptable to both men and women. Most users concluded that intercourse was the same or better with the device than with no product. About 73% would choose Duet over male condoms, and no one preferred the standard diaphragm. Colposcopic findings were noted in 79% of women with external genital findings (9) or cervicovaginal peeling (18) predominating. Only one finding breached the epithelium. Most product-related adverse events were mild (10/11) and confined to the genitourinary tract. The successful placements and acceptability suggest that further product development is warranted and could target over-the-counter use. During increased duration of use or more frequent dosing, cervicovaginal monitoring is advised based on the extent of peeling and external colposcopic findings in this short-term study.
U.S. HIV/AIDS and family planning/reproductive health assistance: A growing disparity within PEPFAR focus countries
Source: Washington, D.C., Population Action International, 2008 Jan.
URL: http://tinyurl.com/2xh85n
Voluntary FP/RH programs, a proven successful intervention long supported by the U.S. government, is critical to the health and well being of women, children and families around the world, and is an acknowledged key component to the success of HIV prevention, care and treatment programs. Dangerously low and declining support for family planning, compounded by restrictive policies, jeopardizes gains in women's health, poverty reduction, and undermines the major investments attempting to curb the spread and impact of HIV/AIDS. To enhance
PEPFAR's successes to date and ensure its sustainability in the future, improved funding for and coordination with FP/RH programs are paramount. This report includes graphs and figures comparing the funding levels, fertility rates, and HIV prevalence in selected PEPFAR countries.
Women's perceptions and experiences of HIV prevention trials in Soweto, South Africa
Authors: Stadler JJ, Delany S, Mntambo M
Source: Social Science and Medicine. 2008 Jan;66(1):189-200.
URL: http://tinyurl.com/2s2zps
Persistently high rates of HIV infection in sub-Saharan Africa have driven the exploration for additional methods of prevention, such as microbicides. Multi-site, field-based clinical trials of microbicides are conducted in diverse social and cultural contexts. Local social and cultural perceptions of HIV/AIDS and sexual risk can have profound implications in shaping community responses to the clinical trials, thereby affecting enrolment and retention. Moreover, clinical trials may have a significant impact on trial participants with regard to their views of AIDS, health and relationships. Following these issues, this paper explores the subjective experiences of women enrolled in a microbicide feasibility study. Qualitative data were collected in two phases. The first phase took place prior to the inception of the feasibility study. Men and women from Soweto participated in focus group discussions about their perceptions and experiences of the AIDS epidemic and sexual risk. The second phase started once enrolment into the feasibility study had begun. Twenty-one women who were enrolled in the microbicide feasibility study were interviewed and participated in focus groups, and were asked about their experiences of participating in the microbicide feasibility study. Special attention was placed on how they felt their participation had affected their everyday lives. Interviews and discussions were conducted in local languages, recorded, translated and transcribed. Data were analysed thematically. The central finding of this study is the sense of empowerment that feasibility study participants felt in spite of their being embedded in a culture that has come to fear, deny or ignore AIDS. We discuss the critical role of repeated, voluntary counselling and testing, knowledge of HIV status, and heightened awareness of sexual and reproductive health in reshaping study participants' approaches to sexual relationships and AIDS, as well as the benefits that participation entailed.
Fertility desire and family-planning demand among HIV-positive women and men undergoing antiretroviral treatment in Addis Ababa, Ethiopia
Authors: Tamene W, Fantahun M
Source: African Journal of AIDS Research, 2007 Dec
URL: http://tinyurl.com/27v9sa
Little information exists about desire to have children and family-planning use among HIV-positive individuals and how this may vary according to individual, social, health and demographic characteristics, especially in developing countries. To assess these topics in Ethiopia, a facility-based cross-sectional study was undertaken among 460 HIV-positive individuals receiving follow-up care at antiretroviral treatment (ART) centres in six public hospitals in Addis Ababa in 2006. One hundred and nine of the women (44.7%), 76 of the men (35.2%), and 40.2% overall of the HIV-positive individuals receiving care desired to have children. In comparison to those who said they did not desire to have children, those who did desire children tended to be younger (18-29 years) (adjusted odds ratio [OR]: 3.05, 95% CI: 1.5-6.4), married or in a relationship (adjusted OR: 3.4, 95% CI: 2.1-5.6), without a child (adjusted OR: 11.5, 95% CI: 5.3-24.9), and with a partner who also desired to have children (adjusted OR: 38.7, 95% CI: 16.7-89.1). Two hundred and forty-six individuals (53.5%) were using family planning (e.g. condoms, abstinence, injectables) and 85 wanted to use family planning in the future. The fertility desire and family-planning needs of these ART clients have implications for preventing vertical and heterosexual transmission of HIV, and the need for appropriate counselling and delivery of services.
A randomized controlled safety trial of the diaphragm and cellulose sulfate microbicide gel in sexually active women in Zimbabwe
Authors: van der Straten A, Napierala S, Cheng H, Mauck C, Depineres T
Source: Contraception, 2007 Nov
URL: http://tinyurl.com/2oafh3
Cellulose sulfate (CS) is an antimicrobial and contraceptive agent. We assessed its safety when used alone or with the diaphragm in Harare, Zimbabwe. This was a randomized controlled safety trial with three arms: diaphragm with 6% CS gel vs. diaphragm with KY gel vs. CS gel alone. Participants were instructed to use their study products before every sex act for a period of 6 months. Safety end points were assessed monthly by questionnaires and urinanalysis and bimonthly by clinical examinations, colposcopy, wet mounts and gram stains. One hundred nineteen monogamous women were enrolled (28% HIV+) and 105 (88%) completed the study. No urinary tract infections were diagnosed during the study; 81.4% women had symptoms and/or signs of genital irritation considered at least possibly related to the gel or device, and 41.5% had changes in vaginal flora. There were no statistically significant differences between treatment groups in safety end points. All six women with deep epithelial disruption were diaphragm users, and all such findings were on the external genitalia. Of those, 4 had herpetic ulcers which were unrelated to products use. Cellulose sulfate appeared safe when used for 6 months alone or with a diaphragm.
Does the delivery of integrated family planning and HIV/AIDS services influence community-based workers' client loads in Ethiopia?
Authors: Creanga AA, Bradley HM, Kidanu A, Melkamu Y, Tsui AO
Source: Health Policy and Planning, 2007 Nov
URL: http://tinyurl.com/3xh2op
Community-based reproductive health agents (CBRHAs) can increase community knowledge of and offer immediate access to reproductive health services, including HIV/AIDS. Due to growing interest in integration of family planning and HIV services in Ethiopia, it is important to examine whether CBRHAs are efficiently offering both service types. The present analysis uses survey data collected from Ethiopian CBRHAs and examines associations between agents' demographic, personality and work-related characteristics and their capacity to provide integrated services and have high client volumes. Multivariate probit and bivariate probit regression models are fitted for the two outcomes of interest. Nearly half of CBRHAs in our sample offer integrated services, but this is not jointly associated with increased productivity. Personality traits and work experience are more strongly associated with agents' capacity to provide integrated services than demographic characteristics, while agents' gender and work-related characteristics are significantly associated with increased likelihood of serving more clients.
Contraception among HIV concordant and discordant couples in Zambia: A randomized controlled trial
Authors: Mark KE, Meinzen-Derr J, Stephenson R, Haworth A, Ahmed Y
Source: Journal of Women's Health. 2007 Oct; 16 (8):1200-1210.
URL: http://tinyurl.com/356od4
This study examines the impact of an intervention to promote dual-method contraceptive use among HIV concordant and discordant couples already using condoms for HIV prevention. A three-armed randomized, controlled trial was conducted at a voluntary HIV testing and counseling clinic in Lusaka, Zambia; 251 couples were randomized. Control couples received family planning education and referral to an outside clinic for nonbarrier contraceptives, intervention 1 couples received education and offer of contraceptives at the research clinic, and intervention 2 couples received intervention 1 plus a presentation designed to reduce outside pressures to conceive. There was a 3-fold higher contraceptive initiation rate in both intervention arms compared with the control arm. The interventions had no impact on incident pregnancy, largely due to high levels of contraceptive discontinuation and user failure. HIV-positive women who initially selected injectable contraception were less likely to abandon the method and significantly less likely to conceive than other study participants. Improving access to nonbarrier contraceptives among couples already using condoms for HIV prevention increased dual-method use. Selection of longer-acting injectable contraception was associated with lower pregnancy rates among HIV-positive women. Further research is needed to identify ways to help couples in this population continue to correctly use nonbarrier contraceptives.
Integrating family planning with antiretroviral therapy services in Uganda
Authors: Farrell B, Rajani N
Source: New York, New York, Engender Health, ACQUIRE Project, 2007. 4 p.
URL: http://tinyurl.com/2cjlgy
In Sub-Saharan Africa, HIV affects women disproportionately, particularly young women. In many of the worst-hit countries of the region, 10% to 30% of pregnant women are HIV-positive (UNAIDS). Family planning (FP) can help ease the burden of HIV and limit new occurrences of HIV infection by decreasing unintended and unwanted pregnancies in HIV-positive women, thereby preventing the transmission of HIV from mother to child. Not only is FP the most effective measure in the prevention of mother-to-child transmission of HIV (PMTCT), but it also improves the health and well-being of families by facilitating the spacing or limiting of births. Additionally, condoms-an FP method-prevent transmission of HIV to a partner. FP is an integral component of safe and comprehensive HIV treatment and care services. However, it is often overlooked as a preventive measure, as the health care system's focus is primarily on offering curative care or responding to the medical and social needs of HIV-positive women and couples. In addition, society has often presumed that people living with HIV (PLHIV) should not have sex or bear children. However, now that HIV is becoming more controllable due to the increased access to antiretroviral therapy (ART), an increasing number of PLHIV are living longer and fuller lives and planning families. They have the same right to and need for comprehensive, safe, and effective FP as their uninfected peers. Meeting the FP and reproductive health rights and needs of PLHIV should be a high priority. The World Health Organization (WHO) has taken an important step by updating its international guidelines and including contraceptive methods that can be used by HIV-positive women. (excerpt)
Male circumcision no aid to women in study
Author: Altman L
Source: New York Times; 4 Feb 2008
URL: http://tinyurl.com/2j3k6l
A new study showed that male circumcision conferred no indirect benefit to the female partners and, indeed, increased the risk if the couples resumed sex before the circumcision wound was fully healed, usually in about a month. The study - conducted by the same team of researchers from Johns Hopkins and Uganda who had shown circumcision's benefits among men in earlier studies - is believed to be the first clinical trial to provide scientific data on the effects on women of circumcision in their male partners. Although the findings did not reach statistical significance, they still underscore the need for more effective education among men who undergo circumcision and their female partners, the authors of the study said.
Improving health, improving lives: Impact of the African Youth Alliance and new opportunities for programmes
Author: Daniels U
Source: African Journal of Reproductive Health. 2007;11(3):18-27.
URL: http://tinyurl.com/yp6zzj
The African Youth Alliance (AYA) was a partnership to improve adolescent sexual and reproductive health, and prevent HIV/AIDS in Botswana, Ghana, Tanzania and Uganda. The AYA model was a comprehensive range of integrated interventions, implemented concurrently and at scale using a multi-sectoral approach. AYA was funded for five years (2000-2005) with $56.7 million from the Bill and Melinda Gates Foundation. Over 35,000,000 stakeholders were reached through media campaigns, almost 400,000 young people received Life Planning Skills training, and over 2,500,000 visits were made by young people to static clinics and outreach services. A post-test evaluation was conducted by John Snow Inc. (JSI) in 2006 and combined case-control and self-reported exposure design. Case-control design data were analyzed using Propensity Score Matching (PSM), and the Self-Reported Exposure design data were analyzed using PSM and Instrumental Variable (two-stage regression) (IV). The results show AYA's significant and positive treatment effects on sexual knowledge, attitudes, and behaviours. The research suggests a comprehensive, multi-component approach such as AYA's can be effective in improving some key ASRH variables.
Pregnancy, hormonal contraceptive use, and HIV-related death in Rwanda
Authors: Allen S, Stephenson R, Weiss H, Karita E, Priddy F
Source: Journal of Women's Health, 2007 Sep
URL: http://tinyurl.com/2m3qnr
Few studies have examined the influence of pregnancy and hormonal contraception on HIV-related deaths in African women. Rwanda is a country with high fertility, high HIV prevalence, and frequent use of hormonal contraception in urban areas. Data from a prospective cohort study of 460 HIV-infected urban childbearing (18-35 years) women followed at 6-monthly intervals for 6 years in Kigali, Rwanda, were analyzed. The relationship of time-dependent measures of pregnancy and hormonal contraceptive use to death from HIV disease was assessed with multivariate models. Incident pregnancy was not associated with elevated risk of death among HIV-infected women. Oral and injectable hormonal contraceptive use had borderline protective effects associated with reduced mortality (HR 0.40, 95% CI 0.15-1.07 and HR 0.48, 95% CI 0.21-1.08 for mortality, respectively) in a multivariate model including time-dependent measures. The results point to the benefits of integrating family planning and HIV services. In a highly pronatalist society, such as Rwanda, which is experiencing high HIV prevalence, service integration affords an opportunity to provide HIV testing to women at risk of pregnancy and to promote family planning among HIV-positive women.
Events
This section lists upcoming public health conferences, meetings, or other events that include activities and information concerning HIV/AIDS and Sexual and Reproductive Health Integration. If you know of an upcoming event that may be of interest to HIV/SRH Integration professionals, please e-mail info@hivandsrh.org.
Youth Deliver the Future: Investing in Young People's Health and Development: Research that Improves Policies and Programs, in Abuju, Nigeria. April 27-29, 2008.
URL: www.jhsph.edu/gatesinstitute/policy_practice/adolhealth
Reproductive Health in Emergencies Conference, 2008. June 18-20, 2008, Kampala, Uganda.
URL: www.raiseinitiative.org/conference/
XVII International AIDS Conference, in Mexico City. Aug. 3-8, 2008.
URL: www.aids2008.org/
Partner Profiles: Voices from the Field
From Bangladesh to Botswana, healthcare professionals learn lessons and achieve successes implementing HIV/SRH Integration programs using a variety of innovative strategies. Read the following "Voices from the Field" interviews to hear about Integration programs in a variety of countries.
Dr. Ferdousi Begum - NGO Service Delivery Program, Bangladesh
http://www.hivandsrh.org/Voices/Begum.php
Dr. Begum has more than 16 years of experience working for different cooperating agencies of USAID-Bangladesh, both in service provision and program management.
Nfila Chalebiwa Chikadze - Community Home Based Care and Orphan Care, Ministry of Local Government, Botswana
http://www.hivandsrh.org/Voices/Chikadze.php
Nfila Chalebiwa Chikadzi currently serves as a Policy Advisor for the Community Home Based Care (CHBC) and Orphan Care programs run through the Ministry of Local Government in Botswana. She provides technical guidance, direction and support to officers in charge of CHBC and Orphan Care programming at the district level.
Rita Badiani - Geraçao Biz, Pathfinder International, Mozambique
http://www.hivandsrh.org/Voices/Badiani.php
Ms. Badiani is responsible for designing and implementing the national Adolescent Sexual and Reproductive Health/HIV/AIDS program in Mozambique entitled "Geraçao Biz," which was featured as the "Best Practice Model" in the World Bank Resource Book.
Rehana Ahmed, MD- Top Réseau, Population Services International, Madagascar
http://www.hivandsrh.org/Voices/Ahmed.php/
Dr. Ahmed works on the Top Réseau project, a franchised network of private clinics started in 2000 to improve access to quality, affordable sexual and reproductive health services among vulnerable groups, in particular youth. At present, 146 Top Réseau clinics and 204 doctors exist in seven large cities of Madagascar. In 2004, requests for HIV test represented 10% of young clients' reasons to visit Top Réseau's health centers for reproductive health services.
Paul Perchal - Global HIV/STI Program, EngenderHealth, Brazil, Ethiopia, Ukraine
http://www.hivandsrh.org/Voices/Perchal.php
As Director for EngenderHealth's global HIV/STI program, Paul Perchal provided technical and management oversight of a project to strengthen existing PMTCT services in three countries: Ukraine, Ethiopia, and Brazil, and particularly looking at two core elements of comprehensive PMTCT: addressing the HIV prevention needs of pregnant, postpartum women and also the sexual, reproductive health, and family planning needs of HIV-positive women.
Subscription Information
Quarterly Highlights is a free electronic newsletter, distributed by e-mail four times a year, and archived on http://www.hivandsrh.org. To subscribe, visit http://www.infoforhealth.org and register to set up a free account. Under "Subscriptions," select "HIV and SRH Integration Web Site News."
Interested in submitting resources to the HIV/SRH Integration Web site or sharing a story with us about your country or organization's experience with integrating programs? Please send e-mail to: info@hivandsrh.org.
|
The Pop Reporter®
A free weekly electronic magazine that highlights the latest research and news in the field of reproductive health. Access information quickly and easily to create educational materials, presentations, proposals, or to simply increase your own knowledge.
Subscribing is fast and easy, so sign up today!
|
You can also receive Pop Reporter in English or Spanish in your RSS (Really Simple Syndication) reader. Visit http://www.infoforhealth.org/popreporter/ (for English) or http://www.infoforhealth.org/popreporter/es/ (for Spanish). Click on the RSS icon (orange box) next to "Current Issue" for the link to the RSS feed.
How to Request Copies of Full-Text Documents
Developing country users can request full-text copies of many of the documents listed in Quarterly Highlights. To request a copy of a document, click on the document URL or copy and paste the URL into your Web browser. You will be redirected to the Integration database, where you can add a document to your shopping "basket" after you set up a free user account.
HIV/AIDS and Sexual and Reproductive Health Integration: Quarterly Highlights is published by the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs. It is made possible through funding from the David and Lucile Packard Foundation and the William and Flora Hewlett Foundation.